Switching renal transplant recipients to belatacept therapy results of a real-life gradual conversion protocol.

Switching renal transplant recipients to belatacept therapy results of a real-life gradual conversion protocol. Transpl Immunol. 2019 May 06;: Authors: Malvezzi P, Fischman C, Rigault G, Jacob MC, Raskovalova T, Jouve T, Janbon B, Rostaing L, Cravedi P Abstract Conversion to belatacept immunosuppression is a therapeutic option for renal-transplant recipients with calcineurin inhibitors (CNI) toxicity, but it associates with high risk of acute rejection. Gradual conversion and serial immune monitoring with urinary chemokine CXCL9 may allow increasing safety of this maneuver. We converted kidney transplant recipients with signs of toxicity to CNI or other immunosuppressive drugs to belatacept over a 2-month period. We monitored renal function, metabolic profile, and circulating lymphocyte subsets. We also quantified urinary CXCL9 over a 12-month follow-up period. Between September 2016 and March 2017, 35 patients were successfully switched to belatacept immunosuppression at 3.3 (1.3-7.2) years after transplant. Two patients had a reversible rise in serum creatinine, associated with acute rejection in one case. Urinary CXCL9 increased before serum creatinine. After conversion, blood pressure and HbA1c significantly declined while eGFR and proteinuria remained stable. The percentage of circulating effector T cells and memory B cells significantly declined. Conversion from CNI to belatacept, in this setting, was feasible and safe, provide...
Source: Transplant Immunology - Category: Transplant Surgery Authors: Tags: Transpl Immunol Source Type: research